Related Experiment Video
Updated: Jul 17, 2026
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
The white-eyed medial blowout fracture
Raymond Tse1, Lawrence Allen, Damir Matic
1London, Ontario, Canada From the Division of Plastic and Reconstructive Surgery and Department of Ophthalmology, University of Western Ontario.
Insights
Early surgical intervention for pediatric medial orbital wall fractures with medial rectus muscle entrapment is crucial. Prompt release and reconstruction prevent long-term vision issues and ensure full recovery of eye movement.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Trauma Surgery
Background:
- Pediatric white-eyed blowout fractures with inferior rectus muscle entrapment are often missed injuries.
- A series of five isolated medial orbital blowout fractures with medial rectus muscle entrapment was analyzed.
- This study aimed to define this specific injury pattern and its clinical outcomes.
Purpose of the Study:
- To define the clinical presentation and outcomes of isolated medial orbital blowout fractures with medial rectus muscle entrapment in pediatric patients.
- To emphasize the importance of early recognition and treatment of this rare injury pattern.
Main Methods:
- A retrospective review of case presentations, management strategies, and clinical outcomes was performed.
- Analysis included five cases of isolated medial orbital blowout fractures with medial rectus muscle entrapment.
Main Results:
- Early surgical exploration, muscle release, and medial orbital wall reconstruction within two weeks led to complete resolution of diplopia and full recovery of extraocular movements.
- Delayed treatment without orbital wall reconstruction resulted in persistent gaze restriction and diplopia.
- Outcomes in reported cases corroborated these findings.
Conclusions:
- Pediatric orbital floor fractures have a high incidence of muscle entrapment requiring early recognition and treatment to prevent necrosis and permanent ocular restriction.
- Medial orbital wall fractures with entrapment are rare but benefit significantly from early surgical release of entrapped muscles for improved outcomes.
Background:
The pediatric white-eyed blowout fracture with entrapment of the inferior rectus muscle is well recognized as an easily missed injury with significant morbidity if left untreated. A series of five isolated medial orbital blowout fractures with medial rectus muscle entrapment is described. The purpose of this study was to define this injury pattern and its clinical outcome.
Methods:
A retrospective review of the presentation, management, and clinical outcomes of identified cases was conducted.
Results:
Early exploration and release of the entrapped muscle combined with implant reconstruction of the medial orbital wall within 2 weeks resulted in complete resolution of diplopia and full recovery of extraocular movements. Delayed treatment and release of the soft tissues without orbital wall reconstruction were associated with restricted gaze and diplopia. Similar outcomes were confirmed on analysis of other reported cases.
Conclusions:
Orbital floor blowout fractures in the pediatric population have a high incidence of muscle entrapment that must be recognized and treated early to avoid muscle necrosis and permanent ocular restriction from fibrosis. Medial orbital wall fractures with entrapment are rare, but early recognition and operative release of the entrapped muscles result in better outcomes.
